Placental Pathology: Useful for Undiagnosed Small for Gestational Age Neonates? [14A]

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Abstract

INTRODUCTION:

Up to 75% of babies born growth restricted were undiagnosed prior to delivery. Certain placental changes have associated with growth restriction. Our objective is to determine if these changes are increased in cases with ultrasound estimated fetal weight (EFW) 10-20%.

METHODS:

Retrospective analysis on singleton placentas from 2011 to 2016. Exclusion criteria were less than 24 weeks’ gestation or EFW <10%, multiple anomalies, known aneuploidy. Primary outcome was decreased placental weight. Secondary outcomes were infarcts, villitis, fibrin deposition, calcium deposition and a composite of outcomes. Pathology reports, ultrasound reports, and the electronic medical records were reviewed. Chi square was used for categorical variables and logistic regression for adjusted analyses.

RESULTS:

1748 ultrasounds had with EFW >10th%. Pregnancies with EFW 10-20% were more likely in women who were younger, nulliparous, had lower BMI, less gestational weight gain, and delivered less than a week earlier (p<0.05). Rates of SGA at birth were also increased (69.2% vs 8.7%, p<0.001). Placental pathology was sent in 35 (37%) of EFW 10-20% pregnancies and 281 (17%) those with EFW>20%. There were more placentas with decreased placental weight in the EFW 10-20% group (p<0.005). There was a trend toward increase in the incidence of infarcts, villitis, no differences in any of the other secondary outcomes, except decreased placental weight and one other placental finding (p=0.005).

CONCLUSION:

Placentas from pregnancies with EFW 10-20% had higher rates of decreased placental weight. No difference found in secondary outcomes, but with small numbers, further research is needed to assess these outcomes.

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